Clark W C, Daniels C E, Dedrick R L, Girton M E, Doppman J L, Oldfield E H
J Neurosurg. 1985 Apr;62(4):576-9. doi: 10.3171/jns.1985.62.4.0576.
Circulation of blood in the ipsilateral jugular vein through an extracorporeal circuit for drug removal during intracarotid chemotherapy has recently been reported to decrease the systemic drug exposure. The reduced systemic exposure achieved by the use of this technique should permit a several-fold increase of the intracarotid dose of chemotherapy without increasing systemic toxicity. To determine the influence of the rate of blood removal from the jugular vein on the fraction of the blood flowing through the ipsilateral internal carotid artery (ICA) collected for extracorporeal drug removal, the authors aspirated blood from the jugular bulb into an extracorporeal circuit at varying rates during a constant infusion of the indicator dye, indocyanine green (ICG), into the ICA of rhesus monkeys. The fraction of the ipsilateral carotid blood channeled into the extracorporeal circuit increased linearly with the rate of aspiration of jugular blood. This suggests that the absence of valves in the intracranial venous system should permit increasing fractions of drug removal during intracarotid infusion by increasing the rate of collection of venous blood from the ipsilateral jugular bulb. The measurement of ICG concentrations in a similar manner in patients undergoing isolated perfusion may prove to be a clinically useful method for estimating the maximum safe dose in high-dose intra-arterial chemotherapy.
最近有报道称，在颈内动脉化疗期间，通过体外循环使同侧颈静脉血液流通以进行药物清除，可降低全身药物暴露量。使用该技术实现的全身暴露量降低应能使颈内动脉化疗剂量增加数倍，而不增加全身毒性。为了确定从颈静脉抽血速率对为体外药物清除而收集的流经同侧颈内动脉（ICA）的血液比例的影响，作者在向恒河猴的ICA持续输注指示剂染料吲哚菁绿（ICG）期间，以不同速率将颈静脉球部的血液抽吸到体外循环中。进入体外循环的同侧颈动脉血液比例随颈静脉抽血速率呈线性增加。这表明颅内静脉系统中不存在瓣膜，应可通过增加从同侧颈静脉球部收集静脉血的速率，在颈内动脉输注期间增加药物清除比例。在接受单独灌注的患者中以类似方式测量ICG浓度，可能被证明是一种临床上有用的方法，用于估计大剂量动脉内化疗中的最大安全剂量。
